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#4974
Enhancing the empiric antibiotic selection by introducing an antibiogram toolkit in a tertiary care hospital in Southern India–A prospective study


What is Known and Objective

Antibiograms gives an overview of the cumulative susceptibility of formal antibiotics to bacterial isolates, which reflects the portion of each bacterium susceptible to a given antibiotic formulation by using antimicrobial susceptibility testing. The objective of this study is to gather and analyse data from drug utilization evaluation (DUE) studies and antimicrobial susceptibility tests in order to create an antibiogram toolkit that will help clinicians to select appropriate antimicrobial agents for initial empirical antibiotic therapy at point of care settings and avoid irrational use of antibiotics.

Methods

A prospective interventional study was conducted at tertiary care hospital, biological samples of infectious patients were collected from various wards as per Clinical & Laboratory Standards Institute CLSI M39-A4 guidelines. Antimicrobial susceptibility results were analysed using WHONET software. Antibiotic stewardship committee was formed and involved in monitoring the usage of antibiotics, measuring outcomes, collecting feedback and finding the scope for improving the application of antibiogram toolkit in the hospital. Antibiotic usage tracking method was followed to know the level of adherence to the prescribing guidelines by the health care professionals.

Results and Discussion

A total of 157 samples were obtained from various wards of the hospital. In that, Escherichia coli, Staphylococcus aureus and Klebsiella Pneumoniae were isolated in significant numbers. Antibacterial susceptibility results were collected, an initial antibiogram was developed for 18 antibacterial agents with respect to 3 gram-positive (+) and 1 gram-negative (−) organisms. 90% of prescribers mentioned that the antibiogram was useful, and 76% of them adhered to the guidelines. 26% were not adhered due to the patient-related factors.

What is New and Conclusion

In our study, we have used qualitative and quantitative evaluation of drug utilization (DUE) reports to understand the existing prescribing pattern of antibiotics and setting target organisms and antibacterials to develop the hospital antibiogram. Combining DUE studies and antibiogram development was helpful in implementing effective antibiotic policies for the hospital. Further, this study pattern will be continued on a yearly basis and focused on developing cumulative antibiograms to understand the changes in resistance pattern of antimicrobials and utilization of antibiotics in the hospital.

Download the article from here - https://onlinelibrary.wiley.com/doi/abs ... jcpt.13571

PubMed Link—Click Here

Citation Details:

Sadagoban K, Raj V, Viswanathan B,Dhanasekaran GP, Palaniappan D, Borra SS. Enhancing the empiric antibiotic selection by introducing an antibiogram toolkit in a tertiary care hospital in Southern India – A prospective study. J Clin Pharm Ther. 2021;00:1-10. doi:10.1111/jcpt.13571
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#5048
This work helped a lot for knowing more about the preparation of an antibiogram. I have a doubt regarding the title. The title is "Enhancing the empiric antibiotic selection by introducing an antibiogram toolkit". An Antibiogram is based on the culture test result, for knowing the susceptibility of the particular microorganism towards the antimicrobial angents. For selecting an antibiotic by using an antibiogram we need to know the microorganism that caused, also for getting the test result it will take about 24hr so.. How we can select the empiric antibiotic using an antibiogram? because empiric therapy is the first treatment that is given to a patient with only an assumption, so what is the reason for the title empiric antibiotic selection by using an antibiogram?
#5049
AshikAnilMathew wrote: 03 Mar 2022, 18:03 This work helped a lot for knowing more about the preparation of an antibiogram. I have a doubt regarding the title. The title is "Enhancing the empiric antibiotic selection by introducing an antibiogram toolkit". An Antibiogram is based on the culture test result, for knowing the susceptibility of the particular microorganism towards the antimicrobial agents. For selecting an antibiotic by using an antibiogram we need to know the microorganism that caused, also for getting the test result it will take about 24hr so. How we can select the empiric antibiotic using an antibiogram? Because empiric therapy is the first treatment that is given to a patient with only an assumption, so what is the reason for the title empiric antibiotic selection by using an antibiogram?
Empiric section of antibiotic bound to happen when there is no culture and sensitivity findings are available for a particular infection or if the condition is a life-threatening & emergency. To make it rationale, antibiograms are used as a tool to understand the current resistance and susceptibility of organisms against commonly used antimicrobials at their local settings.

Also, this helps the prescribers to know the followings by including DUE studies;

1. Major causative organisms for an infection in the local population/hospital/ward.

2. List of antibiotics that works against each organism.

For an example, for an UTI infection, the prescriber will try to target e-coli by default due to its prevalence rate and other known risk factors and field experiences.
As you said, it's an assumption. But assumptions are limited to organism's but not with the selection of right antibiotics.

In this context, antibiograms will be helpful to make rational empiric selection of antibiotic from the list of antibiotics that works against e coli. Prescribers will be guided indirectly to use narrow spectrum and lower generation of antibiotics and that helps to achieve the desired health outcomes.
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